Mainstream Habilitation Services of Texas, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

116454 Issued in TX

Legal business name

MAINSTREAM HABILITATION SERVICES OF TEXAS, INC.

Practice address

717 Mountain Ridge CT W
Lakeside, TX 76135-4925

Phone

(817) 237-8329

Fax

(817) 238-9606

NPI assigned

May 2, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lisa Ann Smith, MBA

Title

Director of Operations

Phone

(940) 552-2979

Specialties & licenses 4

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sakthiraj Subramanian, MD

  • Internal Medicine Physician
  • Willow Park, TX
  • NPI 1669676326
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679531503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1677",
            "address_2": "1728 PEASE STREET",
            "city": "VERNON",
            "state": "TX",
            "postal_code": "763851677",
            "telephone_number": "940-552-2979",
            "fax_number": "940-552-2987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 MOUNTAIN RIDGE CT W",
            "city": "LAKESIDE",
            "state": "TX",
            "postal_code": "761354925",
            "telephone_number": "817-237-8329",
            "fax_number": "817-238-9606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINSTREAM HABILITATION SERVICES OF TEXAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "940-552-2979",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TX",
            "license": "116454",
            "primary": true
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TX",
            "license": "116728",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TX",
            "license": "116726",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TX",
            "license": "112011",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariella E Clark, LCSW
• Kathi Edmonson
• Kimberli Paige Edmonson, SLP-ASSISTANT
• Noble U. Ezukanma, M.D.
• Chase C McKinney, LPC
• Pathfinder Counseling and Consulting
• Sage Substance Abuse Guidance and Education
• Kelle Creecy White, LCSW-S

• Intellectual Disabilities Intermediate Care Facility in Lakeside, TX
• Providers in Lakeside, TX by specialty
• Intellectual Disabilities Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.